Oral Presentation 6th Australian Health and Medical Research Congress 2012

Nutrition in Pancreatitis (#93)

Nutritional factors have long been implicated in the causation
of pancreatitis; they also have major therapeutic relevance in established
disease.

Dietary intakes of macro- and micro-nutrients in aetiogenesis
of chronic pancreatitis have been studied over the years. Much of this has been informed by the pivotal
role of the enhanced oxidative stress model in the necrosis-fibrosis sequence
that produces the hallmarks of this disease.

Micro-nutrients, such as certain trace element and vitamins,
ostensibly help to quench the reactive oxygen species (ROS) released by
pancreatic injury, which would activate fibrosis mediated by stellate
cells. Evidence for this has come from
observational and experimental studies in humans and animals. However, due to the long course of disease
evolution and perhaps the non-compliant nature of the disease population
itself, causal inference derived from high-level prospective cohort studies and
randomised controlled trials has been difficult to obtain. Further innovative clinical research
strategies may be necessary to strengthen the existing body of evidence.

Nutrition for therapeutic purposes in pancreatitis is focused
on counteracting catabolism in severe acute pancreatitis (SAP), and on ameliorating
deficient exocrine function in chronic pancreatitis and in the recovering
phases of SAP.

In acute pancreatitis, initial severity stratification is
desirable in order to predict ongoing nutritional needs. For SAP, nutritional support is necessary in
the acute phase. Most guidelines
recommend enteral feeding in the presence of an intact gastrointestinal tract,
reserving parenteral nutrition for exceptional cases. In the recovery phase, there may be a benefit
from enzyme supplements during the period of exocrine function recovery, so as
to maximise bio-availability of nutrient intake.

Enzyme replacement is similarly indicated in chronic
pancreatitis, and should be guided by clinical features and tests of exocrine
function. In some cases, vitamin and
mineral supplements may be considered.
Enteral feeding is occasionally indicated where there is gastric outlet
obstruction, or in malnourished patients prior to surgery.